Mental Health and Racism

Mental Health Summit Statement on Racism and Mental Health

In the wake of the murder of George Floyd and others by police officers, the Mental Health Summit believes that it is important for the mental health community to condemn police misconduct towards people of color and other forms of racism.  Racism, in all of its forms, harms the mental health of our state and our country.

  • Our health care system, specifically including the mental health care system, has systematically failed to provide adequate services to people of color. The mental health workforce does not reflect the racial and ethnic diversity of our state and is often not competent to serve the mental health needs of people of color.  People of color are more apt to be misdiagnosed and receive inadequate or inappropriate treatment.
  • As the result of discrimination, people of color have fewer financial resources, lower rates of employment and are less apt to have health insurance.  As a result, they are less apt to be able to secure the full range of mental health services that are available in the private sector.
  • The COVID-19 pandemic demonstrates what is wrong with our health care system and our criminal justice system.   People of color are disproportionately represented in prisons and jails whether they are denied decent mental health care and other necessary health services.   Prisons and jails have become COVID-19 hot spots.   African Americans and Latinos are more apt to be diagnosed with and die from COVID-19.
  • Our criminal justice system systematically mistreats people of color from arrest through imprisonment. Just as too many people with mental health conditions are arrested, convicted and imprisoned, rather than being provided with appropriate mental health services, too many people of color are denied basic human needs, including health care, and punished rather than helped.  Systematic racism also results in the murder of people of color by the police.
  • Mistreatment by the police causes not only physical harm but also depression, anxiety and trauma to those who are its direct victims. Importantly, it also creates anxiety, depression and trauma among others who may understandable fear that they are at greater risk of harm just because they are African American, Latino, Native American or Asian American.
  • Discrimination in employment, housing, education, health care and other aspects of daily life not only denies people of color basic needs, it causes anxiety, depression and trauma among those who are its direct victims and those who understandably fear that they may become so.
  • Fear, anger, mistrust and resentment too often characterize the relationships between people of different races in the United States. This harms the mental health of all of us.

The Mental Health Summit supports the following:

  • Comprehensive reform of the criminal justice system to include:
    • Reduced reliance on the criminal justice system to solve social and mental health problems and an increased reliance on diversion to treatment and social services.  House Bill 5009 and Senate Bill 3449 (which would reduce the use of the police in transporting persons in mental health emergencies) and Senate Bill 1188 (which would divert unfit misdemeanants from the criminal justice system)  are examples of legislation which will move us in this direction.
    • Improved police training, including more and better training and ongoing support needed needed to respond to people with mental health conditions.
    • Improved efforts to identify police officers who themselves need mental health services and ensure that they receive prompt and appropriate care.
    • Improved mental health and substance use services in prisons and jails.
    • Systems to connect everyone leaving a prison or jail to appropriate housing, social services and comprehensive mental health and substance use services when needed.
  • Comprehensive reform of the mental health care system including:
    • Creating a diverse behavioral health workforce
    • Creating a culturally competent behavioral health workforce
    • Ending disparities in the quality and quantity of behavioral health services provided to communities of color
    • Providing adequate funding for behavioral health services
    • Offering mental health services remotely through both video and audio options designed to meet the individual needs of persons with mental health conditions
  • Housing discrimination against people of color increases the likelihood that they will experience negative mental health outcomes. The Summit supports comprehensive efforts to provide safe and affordable housing free from discrimination.
  • Employment, including supported employment for those who need it, dramatically improves mental health outcomes. The Summit supports comprehensive efforts to provide meaningful employment free from discrimination.
  • Providing better mental health and social services in schools in order to reduce or eliminate the number of police officers stationed there.

Here is a link to the BIPOC Mental Health Month Toolkit

 

 

 

 

 

New Medicaid Work Requirement is Misguided (Updated: 2/15/20)

On January 11, 2018 the Federal Center for Medicare and Medicaid Services (CMS) issued a new policy encouraging states to impose work requirements on Medicaid recipients.  This policy is misguided and based upon a false narrative about Medicaid recipients.  For the reasons which follow the  Mental Health Summit urges Illinois policy makers not to impose work requirements as a condition for receiving Medicaid:

  • There is substantial evidence that being employed in meaningful work improves the mental health and general health of most people, including persons with serious mental health conditions.
  • Contrary to the premise of the new CMS policy, there are not a substantial number of persons receiving Medicaid who can work yet are unwilling to do so.
  • Rather, there are substantial barriers to employment for a large number of persons on Medicaid which prevent or discourage them from obtaining and maintaining gainful employment.  Those barriers include:
    • Employment discrimination, frequently based on mental or physical handicaps or the perception of such handicaps, as well as race, religion, ethnicity, gender and sexual orientation.
    • A percentage of Medicaid recipients also are prevented from working because of discrimination based on involvement in the criminal justice system, even though the offenses involved are frequently quite minor.
    • The failure to provide supports to people with handicaps which are sometimes needed to maintain employment.
    • Eligibility requirements for Medicaid, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) discourage people from working due to fear that they will lose these necessary benefits.  This problem may worsen because current Federal policies are undermining the financial viability of the health insurance exchanges created under the Affordable Care Act.  This means that losing Medicaid will effectively deny health insurance coverage to many people.
  • Work requirements are frequently used as mechanisms to deny benefits to people who desperately need them.   Since adequate healthcare is often necessary to restore a person’s ability to work, denying Medicaid to those who do not work, makes sustained employment less likely.  This policy is, therefore, counter-productive to its stated goal.

The Mental Health Summit urges CMS and Illinois to consider policies which will actually increase the likelihood that Medicaid recipients will be employed.  These polices may include:

  • Assistance in obtaining and maintaining employment
  • Increased Federal funding for enforcement of anti-discrimination laws, particularly the Americans with Disabilities Act.
  • Support for legislation and other advocacy to reduce discrimination based upon criminal history.
  • Increased funding for supported employment programs through Medicaid waivers and other programs.

On June 29, 2018, Judge James Boasberg of the United States District Court for the District of Columbia struck down the Medicaid work requirement in Kentucky.

On February 14, 2020, the United States Court of Appeals unanimously struck down the Trump Administrations’ Medicaid work requirements.

Here is link to Kaiser Family Foundation brief on the effects on Medicaid recipients of having a work requirement

Here is a link to the new CMS policy: work requirement for medicaid

Here is a link to Mental Health America’s statement on the rule.

Here is a link to an NPR story about this new rule.

Article on Kentucky work rules

Chicago Tribune column on Medicaid work requirements

Thresholds statement on Medicaid work requirements

American Psychiatric Association statement on Medicaid work requirements

Families USA webinar on the Medicaid work requirement

Protect our Care-Illinois statement on work requirements–PoC IL Coalition Work Requirement Factsheet FINAL

Suit filed challenging legality of work requirement

Repeal of the Affordable Care Act will be devastating for persons with mental illnesses in Illinois

On May 4, 2017, the United States House of Representatives voted 217 to 213 to repeal substantial portions of the Affordable Care Act (ACA).  Notably, every single Democrat in the House, including every single Democratic from Illinois voted “NO.”  Unfortunately, while 20 Republicans from other states also voted “NO,” the entire Republican Congressional contingent from Illinois vote “YES.”

This so-called “Repeal and Replace” bill will cause serious harm to persons with mental illnesses in Illinois.  It will also harm many other people and will seriously worsen the state’s already precarious fiscal condition.

Here are some of the problems:

  • There will be $800 Billion in cuts to Medicaid.   This is bad news for mental health services because Medicaid is the largest funding source for mental health treatment in the state   Under the House bill, states must chose whether to take Medicaid funds as a block grant or per capita funding.  Either way there will be less money and funding for mental health services will have to compete  with other vital health needs for substantially reduced funding.   Additionally, the Medicaid expansion funding which covers people up to 138% of the poverty level is being phased out.   If someone in this program leaves Medicaid for any reason, they will never be able to return.   In the end, several hundred thousand persons in Illinois will lose Medicaid coverage under the House bill.
  • Of course, Illinois could chose to increase its Medicaid funding to make up for these dramatic cuts.  However, given the state’s precarious fiscal situation, this prospect seems unlikely.
  • It is important to remember that, while the Medicaid program provides life-saving health care to several million Illinois citizens, the Medicaid money does not in fact go to poor people.   The money is paid to health care providers, including physicians, hospitals and many others.  Medicaid funding supports thousands of jobs for Illinois citizens who contribute to the financial well being of the state and to its tax revenues.   Illinois will lose hundreds of millions of dollars of economic activity if the ACA is repealed.
  • The ACA requires all health insurance policies to cover “essential health benefits.”  Among those benefits is mental health care.  The Republican repeal eliminates this requirement.  So health insurance may be sold which does not provide ANY coverage for mental health treatment.
  • The Republican repeal also ends the requirement that pre-existing conditions be covered without substantial additional costs.  Health insurance companies will now be free to charge substantially more for pre-existing conditions.

 

What repealing the Medicaid expansion provisions in the Affordable Care Act would mean to Illinois

President Trump has promised to repeal the Affordable Care Act (ACA), often known as “Obamacare.”   However, he and the Republican leaders in Congress have not yet made clear whether some provisions of the ACA will survive and, what, if anything, would replace the ACA.  The ACA provision which has been most helpful to persons with mental illnesses in Illinois is the one which allowed Illinois to substantially expand its Medicaid program.

Under the ACA, states are allowed to chose whether to expand coverage of their Medicaid program.  Historically Medicaid has been available only to persons whose income is at or below 100% of the Federal poverty level.  The Medicaid expansion provisions of the ACA allow persons making up to 138% of the poverty level to be covered.  Importantly, the Federal government covers between 90 and 100% of the cost of care for persons in the Medicaid expansion program.  For persons in the “traditional” Medicaid population the Federal share is typically only 50%.  Thus, Illinois and the 30 other states which have thus far elected to expand Medicaid are able to provide health care to more than 11 million new people at little or no cost to state taxpayers.  In Illinois, more than 650,000 people are now covered by Medicaid due to the expansion provisions of the ACA.  In the 18-month period between January 2014 and June 2015, the Federal government paid $3.3 billion for health care for persons in the Medicaid expansion population in Illinois.  Illinois paid only $52 million as its share–less than 2%.  This data is from “What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?” The Kaiser Commission on Medicaid and the Uninsured (December, 2016)

Illinois is already in very bad fiscal shape. If President-elect Trump and the United State Congress eliminate the Medicaid expansion program, it is extremely unlikely that Illinois would be able to find additional billions of dollars to cover health care costs for more than 650,000 Medicaid expansion enrollees.  Many of these people have serious mental illnesses.  They will no longer be able to get treatment for their mental illness or any other health care condition.  This will harm them and their families and communities.

  1. Action items:  Tell your United States Senator and Congressperson  not to repeal the Medicaid expansion provisions in the ACA.
  2. Show up at a town hall meeting and tell your Senator and Congressperson not to repeal the Affordable Care Act.

Letter to Governor Rauner concerning the possible repeal of the ACA: protect-medicaid-aca-governor-rauner-letter_final_12-15-2016

Click here for a link to a Petition to Save the Affordable Care Act.

Urban Institute; The Implications of Partial Repeal of the ACA.

Latest House Republican plan for ACA repeal 

Click here for a link to the Protect our Care Illinois website.

“Stop gap” budget passed; much more work must be done

On June 30th, the Legislature passed and Governor Rauner signed a so-called “stop gap” budget: Public Act 99-0524.  This budget covers an 18-month period from July 1, 2015 through December 31, 2016.  This is the first actual budget enacted to cover Fiscal Year 2016 which ended on the day the budget was enacted.  The good news is that this budget should enable some mental health and other human services providers to receive payment for services that they have already provided.   However, this does not include some mental health services which were in the Fiscal Year 2015 budget and which providers continued to offer to persons with mental illnesses in the hope that they would eventually be reimbursed.  This further harms many behavioral health care providers whose financial condition is precarious. Click here for a link to some of the cuts to human services providers across Illinois.

Worse still is the fact that Public Act 99-0524 does not contain any new revenue.  This means that every day Illinois’ multi-billion dollar deficit is growing worse.  The budget continues the practice we have had for the past year of spending more money than we are taking in.  This reality has many causes.  However, one of the most important was allowing the state income tax rate to be cut by one third on January 1, 2015.  Because our deficit is getting worse every day, every day it becomes harder for us to solve this problem.  That is because eventually we will need to balance the budget and pay back all of the money we have borrowed.  That means that the amount of new revenue and/or cuts to vital services that will be be needed increases every day.  It is very important that mental health advocates continue to communicate to Governor Rauner, to our state senators and to our state representatives that we need more revenue and we need it as soon as possible.  

We still have no state budget: what must be done.

The 2016 regular session of the Illinois legislature ended on May 31st, 2016 with no state budget.  We have now gone eleven months without a budget.   Every day the state gets further in debt and further behind in paying human services providers.   In human terms that has caused staff layoffs and serious cut backs in community mental health services. Providers that are able to do so, have been borrowing money.  But borrowing money is not free and borrowed money must be paid  back.  In state psychiatric hospitals, there are staff shortages and shortages of every day necessities such as toilet paper, toothpaste and towels.

Enough is enough!!!

Everyone who cares about providing decent and human care and services to persons with mental illnesses should:

  1. Call Governor Rauner and urge him to sign Senate Bill 2038 which restores funding for human services.
  2. Call your State Senator and State Representative and urge them to pass a revenue bill to support funding for human services.  Yes this means a tax increase.  The state is $7 billion in debt and we cannot afford decent mental health services without a tax increase.  Click here to find the contact information for your legislators.

Mental Health Rally Today–May 19th

Persons with mental illnesses, mental health advocates and mental health service providers will come together on May 19, 2016 to protest the extremely painful cuts to mental health and other human services.  Here are the details:

Date:  May 19, 2016

Time:  10 am to 11 am

Location:  Thompson Center Plaza, Northwest Corner of Randolph and Clark Streets, Chicago.  

Every day the harm gets worse.  Now there are shortages of necessities in our state mental hospitals, including toothpaste, mouthwash, soap and toilet paper.  Please bring a roll of toilet paper to the rally.

For more information contact:  Mark Heyrman:  m-heyrman@uchicago.edu

This Rally is sponsored by the Mental Health Summit, Mental Health America of Illinois and NAMI-CHICAGO.

Budget stalemate continues–persons with mental illnesses suffer

On February 16th, 2016, Governor Bruce Rauner presented his proposed budget for Fiscal Year 2017 as required by the Illinois Constitution.  This budget was presented despite the fact that, eight months into Fiscal Year 2016, Illinois does not yet have a budget for the current year.  The Governor’s budget address made it clear that he was not changing his position about what was needed for a settlement.  The responses from the leaders of the Illinois House (Speaker Michael Madigan) and Senate (Senate President John Cullerton) made it clear that they are also not changing their positions.  So the impasse continues with no end in sight.

The details of the Governor’s proposed budget make it clear that funding for mental health services will continue to suffer.   Here are links to the proposed budgets for the Department of Human Services and the Department of Healthcare and Family Services. Important programs for people with mental illnesses are also facing reductions in the budgets for the Department of Aging, the Department of Children and Family Services and the Department of Public Health.

In the meantime, the budget impasse is causing substantial cutbacks in mental health and other human services.  For example, Lutheran Social Services of Illinois, one of the largest social service agencies in the state has been forced to layoff one third of its staff.  These layoffs are the direct result of the failure of the state to pay the numerous human services providers across the state.  Some providers have been able to borrow money to maintain services.  However, that ability declines every day.

Because outside contractors are not being paid and because of other cutbacks, persons confined in state psychiatric hospitals are complaining of shortages of food, clothing and toiletries.  They are also concerned because these facilities are saving money by turning down the heat.  Illinois is becoming a third-world country in its treatment of people with disabilities.

it is past time to resolve this impasse.  Tell the Governor and the legislative leaders that we need a budget NOW which contains adequate funding for persons with mental illnesses.  Among other things, please communicate your support for the Responsible Budget Resolution.

Attached is correspondence concerning shortages at McFarland Mental Health Center, the state-operated psychiatric hospital in Springfieldmcfalrand-full package

Here is a link to more information about the effects of the budget crisis on services in Illinois.

Here is a link to the statement of the Illinois Association of Rehabilitation Facilities before the Senate Appropriations Hearing on March 16, 2016: 2016-03-15 – IARF Statement – Senate Appropriations I – DHS Proposed Budget

Here is a link to the statement of the Community Behavioral Healthcare Association to the Appropriations Committee on March 16, 2016: FY17 Senate Approp I Testimony 031616–cbha

CMS Responds to Our Concerns-Rescinds Proposal to Limit Access to Psychotropic Medications

Responding to a huge outpouring of concerns and complaints from the mental health advocacy community across the country and also to pressure from Congress, the Center for Medicare and Medicaid Services (CMS) reversed its decision to limit access to psychotropic medications.  Virtually every mental health organization in Illinois and across the country communicated to CMS  and to Congress our opposition to this proposal which would have allowed Medicare Part D providers to restrict access to medications for the treatment of serious mental illnesses.  Bravo to everyone who joined in the effort to stop this bad policy from taking effect.

In the meantime, Congress is considering legislation to prohibit CMS from going forward with such a rule.  

Below are links to information about the  CMS change of heart:

Partnership applauds CMS

Obama drops Medicare Proposal

National Council press release

NAMI press release

New York Times article–March 11, 2014

SAVE ACCESS TO MENTAL HEALTH TREATMENT–TELL CONGRESS YOU CARE

The Centers for Medicare and Medicaid Services (CMS) wants to significantly limit access to antidepressant and immunosupressant medication for people subscribing to Medicare Part D. Read today’s post to learn why you should be concerned, and what you can do to support the mental health community by raising our voices in Washington.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would remove antidepressants and immunosupressants from the protected class status under Medicare Part D and is considering removing antipsychotics from the same status the following year. If CMS adopts its proposal, it would reduce patient access to and the availability of mental health treatment.

Since it went into effect in 2006, Medicare Part D’s protected class structure ensures patients with mental health conditions have access to all or substantially all of the most appropriate medications, protecting them from “fail-first”1 experiences or other appeals processes. In many cases, delays caused by these processes can result in inadequate treatment and potentially tragic outcomes.

We need to ensure that all mental health patients have access to all the medications that they need. It is clear that CMS’ rule will signal a step in the wrong direction and the consequences will be detrimental. According to the World Health Organization, depression is currently the leading cause of disability worldwide. By 2030, it will be the leading global burden of disease.2 In the United States alone, the total direct and indirect cost associated with depression exceeds $83 billion annually.3

Ultimately if CMS’ rule is approved, there will be severe human, economic and societal consequences for not only mental health patients, but for all Americans. We must take action now.

Here’s How You Can Take Action Today

Now, more than ever, the mental health community of patients, families, friends and others need to join together to tell CMS and the Administration how big of a mistake implementing this rule will be for all Americans. Below you’ll find several ways in which you can make your voice heard during CMS’ open comment period, ending March 7, to protect antidepressants, immunosupressants and antipsychotics within Medicare Part D. The clock is ticking!

  1. Make Your Voice Heard by writing to your Member of Congress. Use the sample email letter to inform your member of Congress that the implementation of this proposed rule is a big mistake. Be sure to share any personal experiences and how this rule will impact you or a loved one.
  2. Share your personal stories: The Care For Your Mind blog is interested in your personal stories to help share the extent of the issue and how it will impact you or a loved one. While this rule is expected to decrease patient costs for medications, members of the mental health community understand the treatment for our conditions is far from one size fits all. Below are a few questions that may help you shape and share your story:

a. What will happen if you lose access to your medications?
b. Have you had a negative experience with “fail-first” experiences?
c. How will the new rule impact you, your parents, other family members or friends?

We encourage you to submit your personal story here for publication on our website. And in the meantime, join our conversation online by contributing to this blog below. Your voice counts and the time to speak up is now!

Share this information with others: Knowledge is power. The more people know about the proposed rule’s real life consequences, the more we can make our voices heard. Share this post and relevant information with your friends and family, on your social media accounts, through email and word of mouth offline.Together, we can send a powerful message and help ensure that patients have access to the medications they need and deserve.

Here is an action link.

Here is a recent article on this topic